| NPI | 1578797114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AR 3819) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009016779) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2011-09-11 |